TY - JOUR
T1 - A Systematic Review of the Impact of Healthcare Reforms on Access to Emergency Department and Elective Surgery Services
T2 - 1994–2014
AU - Reddy, Sandeep
AU - Jones, Peter
AU - Shanthanna, Harsha
AU - Damarell, Raechel
AU - Wakerman, John
PY - 2018/1
Y1 - 2018/1
N2 - This systematic review sought to identify whether health care reforms led to improvement in the emergency department (ED) length of stay (LOS) and elective surgery (ES) access in Australia, Canada, New Zealand, and the United Kingdom. The review was registered in the PROSPERO database (CRD42015016343), and nine databases were searched for peer-reviewed, English-language reports published between 1994 and 2014. We also searched relevant “grey” literature and websites. Included studies were checked for cited and citing papers. Primary studies corresponding to national and provincial ED and ES reforms in the four countries were considered. Only studies from Australia and the United Kingdom were eventually included, as no studies from the other two countries met the inclusion criteria. The reviewers involved in the study extracted the data independently using standardized forms. Studies were assessed for quality, and a narrative synthesis approach was taken to analyze the extracted data. The introduction of health care reforms in the form of time-based ED and ES targets led to improvement in ED LOS and ES access. However, the introduction of targets resulted in unintended consequences, such as increased pressure on clinicians and, in certain instances, manipulation of performance data.
AB - This systematic review sought to identify whether health care reforms led to improvement in the emergency department (ED) length of stay (LOS) and elective surgery (ES) access in Australia, Canada, New Zealand, and the United Kingdom. The review was registered in the PROSPERO database (CRD42015016343), and nine databases were searched for peer-reviewed, English-language reports published between 1994 and 2014. We also searched relevant “grey” literature and websites. Included studies were checked for cited and citing papers. Primary studies corresponding to national and provincial ED and ES reforms in the four countries were considered. Only studies from Australia and the United Kingdom were eventually included, as no studies from the other two countries met the inclusion criteria. The reviewers involved in the study extracted the data independently using standardized forms. Studies were assessed for quality, and a narrative synthesis approach was taken to analyze the extracted data. The introduction of health care reforms in the form of time-based ED and ES targets led to improvement in ED LOS and ES access. However, the introduction of targets resulted in unintended consequences, such as increased pressure on clinicians and, in certain instances, manipulation of performance data.
KW - elective surgery access
KW - emergency department access
KW - healthcare reforms
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85038438289&partnerID=8YFLogxK
U2 - 10.1177/0020731417722089
DO - 10.1177/0020731417722089
M3 - Review article
SN - 0020-7314
VL - 48
SP - 81
EP - 105
JO - INTERNATIONAL JOURNAL OF HEALTH SERVICES
JF - INTERNATIONAL JOURNAL OF HEALTH SERVICES
IS - 1
ER -